<style type="text/css">
#table2 td{
	
	TEXT-ALIGN: center; BACKGROUND-COLOR: #f7f7f7;padding:9,9,9,9;
	}
#table2 table{
	 FONT-SIZE:12pt;
	  cellspacing: 10; cellpadding: 10;padding:30,30,30,30;
	width:100%;
	}
	#table2 input{
	BACKGROUND-COLOR: #f7f7f7;
	border:none;
	}
</style>



	<form method="post" action="../xinxi/demo/common/ajaxDone.html" class="pageForm required-validate" onsubmit="return validateCallback(this, navTabAjaxDone);">
		<div class="pageFormContent" layoutH="55" style="padding-left:20">
<div id="table2">
<div style="width:98%">
<table class="pageFormContent" width="100%">
			<tr>
<td style="background-color:#f7f7f7;  width:40%">
				<label>工单主题：</label><input type="text"  style=" border:none;" width="500" readonly="readonly" value="中国平安财产保险股份有限公司广东省分公司_平安国内紧急医疗救援卡_无声电话"/>
				
</td>
<td>
				<label>工单流水号：</label><input type="text" name="keyword" size="30" readonly="readonly" value="BJ-010-130305-00001"/>
				<!--<input type="text" class="required" name="orgLookup.orgName" value="" suggestFields="orgNum,orgName" suggestUrl="demo/database/db_lookupSuggest.html" lookupGroup="orgLookup" />
				<a class="btnLook" href="demo/database/dwzOrgLookup.html" lookupGroup="orgLookup">查找带回</a>		-->
	</td></tr></table>
	
	<table class="pageFormContent"><tr><td>

				<label>客户名称：</label><input type="text" name="keyword" size="30" readonly="readonly" value="中国平安财产保险股份有限公司"/></td><td>

				<label>产品名称：</label><input type="text" name="keyword" size="30" readonly="readonly" value="平安健康安心卡"/></td><td>
				<label>产品编号：</label>
				<input type="text" name="keyword" size="30" readonly="readonly" value="0582631535"/>
		</td></tr>
			<tr>
<td>				<label>会员姓名：</label>
				<input type="text" name="keyword" size="30" readonly="readonly" value="王华"/>
</td>
		<td>				<label>会员性别：</label>
								<input type="text" name="keyword" size="30" readonly="readonly" value="女"/>
</td><td>				<label>会员联系方式：</label>
					<input type="text" name="keyword" size="30" readonly="readonly" value="13500899878"/>
</td></tr></table><table class="pageFormContent">
	<tr>
<td>				<label>会员证件类型：</label>
<input type="text" name="keyword" size="30" readonly="readonly" value="身份证"/>
			
</td>
		<td>				<label>会员证件号码：</label><input type="text" name="keyword" size="30" readonly="readonly" value="2203056433455634"/>
</td></tr></table>
	<table class="pageFormContent">
			<tr>
	<td><label>代理人：</label><input type="text" name="keyword" size="30" readonly="readonly" value="华苑"/>
								
</td>
		<td>	<label>代理人联系方式：</label><input type="text" name="keyword" size="30" readonly="readonly" value="15087666543"/>
			</td><td><label>预约省份：</label>
				<input type="text" name="keyword" size="30" readonly="readonly" value="北京"/>
</td>
			</tr>				<tr><td><label>预约城市：</label>
<input type="text" name="keyword" size="30" readonly="readonly" value="北京"/>
			
</td>
<td>				<label>县(区)：</label>
<input type="text" name="keyword" size="30" readonly="readonly" value="朝阳"/>
				
				</select>
			
</td></tr><tr>
<td>				<label>垫付分类：</label>
				<input type="text" name="keyword" size="30" readonly="readonly" value="院前"/>
</td><td>				<label>会员受伤经过：</label>
				<input type="text" size="30"  value="出国旅游意外事故"/>
</td>

</tr>
<tr><td>
<label>备注：</label>
<input type="text" name="keyword" size="30" readonly="readonly"  value="无"/></td>
</tr>
		
	</table>	
		<table class="pageFormContent">
<tr>	
			
<td>				<label>保单号：</label>
				<input type="text" name="keyword" size="30" readonly="readonly" value="00243522565"/>
</td>
		<td>				<label>车牌号：</label>
									<input type="text" name="keyword" size="30" readonly="readonly" value="京U36533"/>
</td><td>				<label>投保人：</label>
				<input type="text" name="keyword" size="30" readonly="readonly" value="李娜"/>
</td></tr>

		<!--<label></label>
				<a class="button" href="fuwuyewu/heyue/heyuexinzeng.html" target="dialog"  title="查看合约明细" width="800" height="480"><span>查看合约明细</span></a>
-->


	
			<tr>

<td>				<label>工单组号：</label>
<input type="text" name="keyword" size="30" readonly="readonly"  value="010"/></td></tr>
	
</table>
			
</div>	</div>	


		</div>
	

</form>
